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R. R. Battu, M. Bhargava, N. Yadav, S. Natesh, A. Vinekar, S. Braganza, P. Vijayan, R. Rodrigues; Intravitreal Bevacizumab for Macular Edema With Cystoid Spaces. Invest. Ophthalmol. Vis. Sci. 2009;50(13):63.
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© ARVO (1962-2015); The Authors (2016-present)
To report the effect of intravitreal bevacizumab in patients with macular edema with cystoid spaces due to diabetes and retinal venous occlusions and arrive at visual prognosticators.
Medical records of patients with a diagnosis of cystoid macular edema (CME) due to diabetic retinopathy [DR] or venous occlusions [ VO ] , and with cystoid spaces and increased Central Macular Thickness (CMT) on Optical Coherence Tomography (OCT), who had had intravitreal injection of Bevacizumab (1.25 mg/0.05ml), were reviewed. Data recorded included: Pre injection BCVA in LogMAR decimels, CMT and Volume, post injection BCVA, CMT and volume, presence or absence of Subretinal fluid (SRF) and the number of injections given. Comparison was made within and between the two groups.
Of the 28 eyes of 27 patients, 14 eyes of 13 patients had diabetic CME, and 14 eyes of 14 patients had vein occlusions (CRVO, BRVO) with CME. At baseline, the DR group (0.64±0.44) had a 3 line better baseline visual acuity than the VO group (0.93±0.5). Within groups, there was a good correlation between the pre-inj acuity, CMT and volume. Most patients in both groups showed significant improvements in CMT and volume. 9/14 eyes showed improvement in VA in the DR group as opposed to only 5/14 in the VO group. The only reliable predictor of VA change was the pre-injection vision, the worse the vision, the less the improvement (p=0.30), although the pre-injection CMT and volume predicted the degree of change in these parameters (p<0.001). Neither the presence or absence of SRF or the number of injections given per eye correlated with any parameter studied.
CME is associated with poorer visual acuity, and more severe cystoid change in Vein Occlusive than in Diabetes. Prognosis for visual improvement following Intravitreal Bevacizumab is better in general for Diabetic CME than Venous Occlusive CME. Both groups respond well morphologically, but this change does not correlate with degree of visual improvement. The main prognostic indicator of visual improvement seems to be the level of pre-inj visual acuity.
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